514I.8  Eligible child.

1.  Effective July 1, 1998, and notwithstanding any medical assistance program eligibility criteria to the contrary, medical assistance shall be provided to, or on behalf of, an eligible child under the age of nineteen whose family income does not exceed one hundred thirty-three percent of the federal poverty level, as defined by the most recently revised poverty income guidelines published by the United States department of health and human services.

2.  A child may participate in the HAWK-I program if the child meets all of the following criteria:

a.  Is less than nineteen years of age.

b.  Is a resident of this state.

c.  Is a member of a family whose adjusted gross income does not exceed one hundred eighty-five percent of the federal poverty level, as defined in 42 U.S.C. § 9902(2), including any revision required by such section.

d.  Is not eligible for medical assistance pursuant to chapter 249A.

e.  Is not currently covered under or was not covered within the prior six months under a group health plan as defined in 42 U.S.C. § 300gg-91(a)(1) or other health benefit plan, unless the coverage was involuntarily lost or unless dropping the coverage is allowed by rule of the board.

f.  Is not a member of a family that is eligible for health benefits coverage under a state health benefits plan on the basis of a family member's employment with a public agency in this state.

g.  Is not an inmate of a public institution or a patient in an institution for mental diseases.

3.  In accordance with the rules adopted by the board, a child may be determined to be presumptively eligible for the program pending a final eligibility determination. Following final determination of eligibility by the administrative contractor, a child shall be eligible for a twelve-month period. At the end of the twelve-month period, the administrative contractor shall conduct a review of the circumstances of the eligible child's family to establish eligibility and cost sharing for the subsequent twelve-month period.

4.  Once an eligible child is enrolled in a plan, the eligible child shall remain enrolled in the plan unless a determination is made, according to criteria established by the board, that the eligible child should be allowed to enroll in another qualified child health plan or should be disenrolled. An enrollee may change plan enrollment once a year on the enrollee's anniversary date.

5.  The board shall study and shall make recommendations to the governor and to the general assembly regarding the level of family income which is appropriate for application of the program, and the feasibility of allowing families with incomes above the level of eligibility for the program to purchase insurance for children through the program.

6.  The board and the council on human services shall cooperate and seek appropriate coordination in administration of the program and the medical assistance program and shall develop a plan for a unified medical assistance and HAWK-I program system which includes the use of a single health insurance card by enrollees of either program.

Section History: Recent form

  98 Acts, ch 1196, §9, 16; 98 Acts, ch 1223, § 34

Internal References

  Referred to in § 514I.2

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